Rheumatoid Arthritis in the Foot and Ankle
You may sometimes get ticked off at yourself. You may even, under extreme
circumstances, berate yourself soundly for mistakes, or attempt to kick
your own bum (a difficult maneuver at the best of times). Like that time
when you poured an entire pitcher of hot chocolate over the French
ambassador. Or worse, when your mother-in-law overheard you telling a
friend that she reminded you of Genghis Khan. Times like that. But your
body might decide to take things a bit further.
You see, normally, your immune system is your body’s defense against
nefarious invaders intent on doing you harm. Your immune system kills these
invaders in pretty much any way possible until you’re brought back to full
health. Sometimes though, the immune system can get overenthusiastic in its
defense: it can start to attack YOU. More specifically in the case of
rheumatoid arthritis (RA), it can attack the lining of your joints.
When this lining (typically in the joints of the hands and feet) becomes
inflamed, it can lead to increased joint fluid, damage in your cartilage or
bones, and may weaken the surrounding soft tissue of your joints. At times,
this damage may become so severe that your joints are permanently deformed
or destroyed, leaving you unable to use them. And rheumatoid arthritis
doesn’t limit itself to joints, either. It can cause problems in your blood
vessels, mouth, lungs and even your eyes.
No one is really sure what causes RA, although there seems to be a genetic
link making some people more susceptible to developing the disease. If a
person is susceptible, there may be an environmental trigger or infection
that leads the immune system to attack the body. Women do tend to be
affected more than men, and the disease usually appears during middle age
(around 25 to 55), although there is a version of the disease called
juvenile rheumatoid arthritis, or Still’s disease, which usually begins
when a child is between the ages of 2 and 5. Unfortunately, there’s no cure
for RA, but it may go into remission for months, years, or permanently.
RA usually starts out as stiffness in the joints, often in the morning. You
may also notice a low-grade fever, fatigue, or weight loss. Joint stiffness
usually develops into joint pain and swelling as the disease progresses,
and you may find rheumatoid nodules (lumps of soft tissue) near your
joints. These nodules can rub against shoes, or make walking painful if
they develop on the bottom of your foot. Walking may also be made difficult
by the pain in the joints themselves.
Your rheumatoid arthritis could also lead to secondary conditions, such as
bunions (often due to the loosening of joint capsules) and hammertoes. It
may even mimic plantar fasciitis and cause pain in your heel. You could
also develop flat feet as a result of RA, or experience Achilles tendon
pain, or even have dislocated toe joints.
Because rheumatoid arthritis can mimic other diseases or conditions, it can
be difficult to diagnose, particularly in the beginning stages. In order to
find out exactly what’s causing your joint pain (or other symptoms), your
podiatrist should take a thorough medical history, especially to get
information about your current symptoms (such as when they started, how
severe they’ve been, etc.). There isn’t really a single test for RA,
although your podiatrist will likely use blood tests, X-rays (or other
imaging technologies) and a physical exam to pinpoint the cause of your
Obviously, the first goal of treatment is to reduce your pain. To do this,
your podiatrist will likely begin with more conservative treatments,
including using orthotics (prescription shoe inserts) to provide support
and help correct some of the misalignments in the foot. Special shoes may
also help accommodate the foot and aid in walking. Your podiatrist may
decide to draw fluid from your joints when they swell in order to relieve
pressure, or inject steroidal medications into your joint to reduce
inflammation and pain.
In some cases, your doctor might suggest surgery as your best treatment
option. There are several types of surgeries that can help ease the
symptoms of RA. For instance, your surgeon may decide that the best course
of action is to fuse your joints, or possibly cut some bones to relieve
pressure and accommodate changes in your foot, or remove some small bones
entirely. If your RA is attacking your ankle, your foot surgeon may opt to
fuse the joint, or replace it entirely with an artificial joint. Whatever
your surgery, be sure to follow your post-operative instructions carefully.
Rheumatoid arthritis can feel like the worst kind of betrayal. And the
disease is often painful and sometimes crippling. The good news is that,
unlike your immune system, your podiatrist is always on your side, and can
provide treatments for you that will help reduce your pain, and allow you
to keep on getting miffed at yourself for other reasons for a long, long
Call 719-543-2476 today to schedule your appointment!